Federal and State governments employ a variety of programs to provide social welfare to its citizens that may fall upon hard times. One such government financed social welfare program, as it is provided to citizens of the United States, includes paying benefits paid to unemployed citizens that have became unemployed through no fault of their own. Other social welfare programs may be provided to citizens of a country that are underpaid, or struggling to raise a family. Furthermore, a wide variety of additional governmental subsidies may be paid to citizens due to their low income and/or employment status. Examples of such support include disability payments, unemployment benefits, retirement benefits, health care coverage and child support payments.
Unfortunately, a number of citizens may be receiving a benefit from the governmental social welfare programs despite their ineligibility to receive such benefits. Governmental agencies providing the assistance have traditionally been forced to rely on the allegations from an applicant or beneficiary regarding his or her employment status, earnings, and other factors affecting eligibility to receive a benefit. The agencies have relied on self-reporting primarily because timely information from independent sources had been unavailable. Further, during harder economic times, the volume of benefit receiving citizens may be so high that it becomes burdensome to verify the eligibility of the citizens to receive the benefits.
Employment information from the state or National Directory of New Hire Databases, the Quarterly Earnings Reports, or the IRS may be up to 18 months old by the time the information is reported to a government agency. Additionally, these sources of information cannot identify potential beneficiaries that may be working “under the table,” or being paid in cash without reporting to an agency, such as the IRS or the Social Security Administration. As a result, state and federal agencies that rely on self-reports from beneficiaries routinely pay benefits to beneficiaries that are ineligible to receive them.
Payment integrity is compromised with the taxpayer picking up the tab for erroneous claims. Whether deliberate fraud, errors, or inadvertent omissions, such payments to ineligible beneficiaries also create stress and burdensome paperwork for beneficiaries who may learn, months after the fact, that they are expected to repay money they have improperly received, but have already spent. What is needed is a timely and independent method of verifying employment and/or income streams that would reduce the frequency with which improper payments occur.
U.S. Pat. No. 7,818,188 to Allsup, et al. discloses a method of recovering overpayment of long-term disability benefits paid to a claimant by a client after the receipt of Social Security disability insurance payment. The Service Provider requests specific information from the Social Security Administration regarding the award of Social Security Disability Insurance benefits, and upon receiving that information the Service Provider may determine the amount of the overpayment. The payee will have previously authorized any overpayment amount to be withdrawn electronically from his or her bank account.
Although the '188 patent is directed to reclaiming overpayment of benefits, it fails to seek relevant information, indicative of fraud on the part of the recipient, or error on the part of the beneficiary or government agency Furthermore, the '188 patent fails to perform an investigative identification of a pattern. In the '188 patent there is no investigation required, but rather the information as to the amount of overpayment is provided to the Service Provider who then simply takes that information and implements a process for recovering the overpayment.
U.S. Pat. No. 7,657,474 to Dybala, et al. discloses one such method for the automated detection of selected patterns of financial transactions characterized as customer or trader behaviors and activities, and specific events or sequence of events. The specific implementation relates to identifying trading compliance violations for transactions involving fixed income securities. In the '474 patent, common elements are linked between multiple events, entities and activities. As the associations extend beyond the original sources, the common elements may be identified through direct or indirect association among the various events, entities and activities. Elements of interest may be retrieved, collected or processed from a general data source and may be stored in a separate database or dataset. As additional elements are evaluated, the matches and the link between elements may also be stored. This process may continue for the various elements and data sources.
The '474 patent, however, does not include a simple solution and, instead, requires application of complex rules that are specific to a particular purpose of identifying trade violations. Furthermore, the '474 patent provides a proposed solution to a narrow problem, with limited applicability and expandability to the effective detection of ineligible beneficiaries of benefits through social welfare programs.
U.S. Patent Application Publication No. 2010/0217701 to Mesilaty discloses evaluating some or all past transactions of the customer and executes an analysis, including statistical calculations and evaluations, according to predefined methods and algorithms, to identify patterns in the transactions of the customer's account. The patterns that may be identified by the application may be further processed and analyzed to produce a prediction sheet, which may estimate other future transactions of the customer's account.
However, the '701 patent limits review of the transactions provide a predictive analysis of future events, without determining the validity of past events. Although the '701 patent may engage in profiling to create a predictive analysis of what the banking transactions should look like, it fails to provide a method to identify deviation from that which would be considered anticipated behavior and also fails to indicate the potential ineligibility of a beneficiary. The '701 patent also fails to disclose requesting a more thorough investigation upon determining potential ineligibility of a beneficiary
It is already the case that government agencies such as the Social Security Administration have, in 2011, began a national program to interface with financial institutions across the country to verify the assets of recipients of Supplemental Security Insurance (SSI) benefits and applicants for such benefits. Through a contractor, for example, Accuity, the Social Security Administration contacts banks in the geographic area in which the beneficiary or applicant lives and requests that the financial organization search their databases for accounts that may be held by the SSI recipient or applicant. When accounts are found, the financial institution provides beginning and end of the month balances for the account holder. While this existing system may assist to verify the assets of a beneficiary, it lacks usefulness for verifying the employment status of the beneficiary, and thus the eligibility to receive a benefit. The existence of current employment earnings, and the amount of those earnings, can be critical factors in determining if applicants are eligible for certain government benefits, or if those already receiving such benefits have become ineligible. As a result, there exists a need to determine the employment status of an intended beneficiary that is lacking in the prior art.
Therefore, there exists a need for a method and system for accessing records, such as from financial institutions, relating to a beneficiary, analyzing the records for patterns indicating employment at a level that would render the individual ineligible to receive a benefit, generating a request for an action to be performed by an agency user, and performing the action that may result in a government agency determining that the beneficiary has received improper payments.